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1st PM Appointment (questions and need advice!)

Hello everyone! I will be going to to my 1st PM appointment next week and have some questions, as well as need some advice. Quick background, emergency eye trauma surgery 10 years ago from a small, thrown shard of wood that completely penetrated the left eye. I have since had tons of surgeries (corneal transplant, artificial lens, cataract removal, eye muscle surgery, eyelid lift, and more). I have always had pain, but ever since my last (failed surgery) last August, my eye gets extremely irritated every morning, as well as throughout the day as I stare at a computer screen all day. At times, my eye is literally so bloodshot that it looks bloody. Sometimes I am left so irritated and uncomfortable that I have to leave work. I have tried several treatments to relieve the pain, but the only thing that has seemed to work has been 15-20mg of Oxycodone. I saw my eye doctor (whom performed the trauma and corneal transplant surgeries) and stressed the pain I endure daily and asked if he could prescribe me something. Long story short, he would not prescribe me any narcotics as he said "he does not have a license to prescribe them", in addition, he said that "I am far too young to get sucked up in that crap since they are very addicting". He advised me to see my family doctor in which I did today. Immediately, my family doctor (whom is the one who has prescribed me over 200 Percocet total for other injuries) said this would be a chronic pain case and wrote me a script for (60) Percocet 5/325 (to get me to the apt) and a referral for a PMS.

Can anyone tell me what to expect at my first appointment. More so, I do not want to say anything that will hurt me at the appointment and what I might receive. Can someone please advise me of my best approach to this to get the medication I truly need? I sometimes can get through the day fine with no need of any kind of medication. With that being said, it is rare so I probably shouldn't even mention that - right? Also, I have heard they normally try to start you on crap (tylenol 3's, etc.) in which I already know from prior attempts do not reduce my pain. Knowing that 15-20mg of Oxycodone has been proven to reduce my pain to about a 2-3, is there a good chance that he will start me off on that? My thoughts are: I am not looking for anything intense or crazy, and also am not needing a huge monthly supply. Just simply 15-20mg of Oxycodone that I can take probably once a day, maybe every other day or whenever I truly am uncomfortable. Also, I plan on going to my appointment in the morning prior to taking any eye drop medication so he can see how horrible and painful my eye looks. Any help or insight anybody can offer would be so greatly appreciated. I just don't know how to approach this. Thank you!


  • You're best bet is to go in and let the doctor do their job. If you go in asking for 15-20mg Oxycodone's, they'll probably show you the door.

  • Best Advice is to go into the doctor with your medication you currently have from your family doctor let them know how it is or isn't working. Also be able to clearly describe the pain your having, how often what makes it better or worse. The doctor will decide from the truthful information they give you what is best for your condition. Also lots of pm doctors will have you sign a pain contract, and also do a drug test. As long as your always on the up and up, you have nothing to worry about. So my best advice is be truthful and honest, and I am sure they will come up with a plan to help the pain. Remember it does take time to build a relationship with a doctor and they usually have seen lots of things over the years.
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  • I went to my new one expecting the same sort of thing that the previous one had offered, but as it turns out he was totally different and better.
    Firstly I explained my pain problems-which were from chronic headaches.
    He then looked at my x-rays.
    Finally, he examined my neck physically.
    (Now that is something that no other doctor had ever done before. They all relied on just x-rays and my comments before making a diagnosis. Invariably it was arthritis! My treatment had been pain killers and cortisone injections.)

    The new doctor said that my arthritis didn't seem bad enough to be causing such pain. But my neck muscles were very tight, and he said that this constant tension was the most likely cause of my headaches.

    He suggested I see a clinical therapist for getting an exercise/ stretching routine going, along with some remedial massage.

    I did that, and the massage gave immediate though temporary relief. Still, it told me that he was on the right track. I continued with this regimen for over a year, until I started taking magnesium chloride. After a year on that, I stopped the massages as I was so much better and the headaches had stopped.

    What I am pleased about is that no heavy drugs, injections, or surgery was mentioned at all, instead it was all aimed at improving my overall body health. And it worked.

    So I'd suggest that you go in with an open mind, and not one centred on a drug therapy. Drugs don't cure, they only mask, and may well make you worse. Avoid drugs as much as you can, especially the addictive ones. They are bad news for long term use.

    Make a point of asking the doctor about what role your soft tissues may be playing in your condition. Joints are only part of the problem.
    Posture, activities, diet and overall health are also part of the diagnosis.
  • You said is very good.
  • Just be honest. I've been treated by two pain clinics, one good and one bad, but they had similar new patient routines. The first appointment was a pretty basic discussion of my medical history, including pain treatment, and honest talk about my expectations. If you have been using something that works they will want to hear all about it. The first clinic I went to didn't like my neurologist's diagnosis and kept trying to come up with their own. I thought they might be right but later learned they had a reputation for putting academic concepts ahead of patient care. Might be a paper in you.

    They then both required a visit with their own psychologists. This was both to help root out the drug seekers and to evaluate me for depression or other psychological issues that might affect my pain. Both psychologists were lovely people and the appointments were no big deal. I had no drug tests, but I suppose the psychologists could have required them.

    After that very low hurdle I was accepted as a patient. The first clinic tried every possible method, however farfetched, that didn't involve controlled substances. Bah. The second paid more attention to what I was on (tramadol, gabapentin, acetaminophen) and how it was working (some, but not great.) We discussed the possibilities and came up with a treatment plan. They did have mesign a drug contract, which sounds serious, and is, but what it basically said is that I would have all my pain treatment only through them and would take my drugs only as prescribed. For me, not a problem.

    That said, there is a very good chance you won't walk out of that appt with an oxycodone prescription. It's designed for acute pain, not chronic, but PCPs are comfortable prescribing it and won't prescribe long-acting drugs more appropriate for chronic pain. Which is why your doc sent you to a pain clinic. Good luck. I like your chances for a happy ending.
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